bubble_chart Concept

The pattern of stomach cold refers to the pathological changes caused by insufficient stomach yang, excessive cold evil, leading to internal cold stagnation, qi stagnation, and the failure of the stomach to harmonize and descend. This syndrome is often caused by factors such as cold evil attacking the stomach, irregular diet, excessive consumption of raw and cold foods, or overuse of cold medicines.

The main clinical manifestations include: a sensation of cold in the stomach, sometimes as if there is ice inside, cold pain and distension, vomiting clear fluid, pain worsening with cold and alleviating with warmth, a pale tongue with white and slippery coating, and a wiry or slow pulse.

The pattern of stomach cold can be seen in diseases such as "epigastric pain," "vomiting," and "diarrhea."

This syndrome should be differentiated from "stomach yang deficiency pattern," "spleen-stomach yang deficiency pattern," and "pattern of cold fluid retention in the stomach."

bubble_chart Differentiation and Treatment

The differentiation of the pattern of stomach cold is commonly seen in patients with insufficient middle yang, such as those with constitutional yang deficiency, prolonged illness damaging the body's vital energy, or overstrain injuring the spleen and stomach, combined with dietary irregularities, excessive consumption of cold and raw foods, or exposure to external cold, leading to damage of middle yang, internal exuberance of cold pathogen, and impairment of the stomach's functions of reception, digestion, and descending. As stated in "Luo's Medical Mirror, Volume 8": "The stomach governs reception... External injury is most often caused by overexertion, which injures the spleen, and when the spleen is injured, the exterior and interior communicate, and the stomach is also affected; internal injury is most often caused by worry, thought, anger, which injures the heart, and when the heart is injured, the mother-child relationship is affected, and the source of transformation is severely blocked, this is the injury caused by overstrain and emotional factors... The spleen and stomach belong to earth, aversion to cold and preference for warmth, unless there is a true fire pathogen, cold and raw substances should be used with caution."

Cold is the dominant qi of winter, but cold pathogen can cause disease in all seasons, characterized by congealing, contracting, and easily injuring yang qi. When cold pathogen injures the stomach, it also exhibits these characteristics, but the clinical manifestations vary in different diseases.

1. The clinical manifestations of the pattern of stomach cold in epigastric pain are: sudden severe pain in the stomach region, refusal to be pressed, a sensation of local cold, worsening pain with cold, and relief with warmth. It is often caused by severe cold in midwinter or excessive consumption of cold and raw foods in summer, leading to cold pathogen attacking the stomach, trapping stomach yang, causing stagnation and accumulation of cold in the middle, congealing cold and qi stagnation, obstruction of qi and blood, and impairment of the stomach's descending function, leading to pain; "cold governs pain," and in this syndrome, the cold pathogen is excessive, hence the severe pain. Treatment should focus on warming the stomach and dissipating cold to relieve pain, using the formula Lesser Galangal and Cyperus Pill (from "Collection of Excellent Prescriptions") for treatment.
2. If vomiting and diarrhea disease present with the pattern of stomach cold, the clinical manifestations are: vomiting and diarrhea. The pain in the stomach region is less severe than in the previous case, accompanied by borborygmus and distending pain around the navel. It is often caused by excessive consumption of cold and raw foods in summer or sleeping in windy and cold outdoor areas, leading to cold pathogen directly attacking the stomach. The cold nature is congealing and obstructing, blocking qi movement, damaging middle yang, and impairing the stomach's descending function; the foot yangming stomach meridian intersects with the hand yangming large intestine meridian, so cold pathogen can also linger in the intestines, causing distending pain around the navel, borborygmus, diarrhea, and other intestinal cold symptoms. Treatment should focus on warming the middle and dissipating cold to stop diarrhea, using the formula Magnolia Bark Middle-Warming Decoction (from Neiwaishang Bianhuo Lun).
3. Clinically, this syndrome is often accompanied by external contraction symptoms such as aversion to cold, body pain, and headache. Treatment should focus on warming the middle and releasing the exterior, using formulas such as Xiang Su San (Hejiju Fang), or Patchouli Qi-Righting Powder (from Hejiju Fang) combined with Middle-Regulating Decoction (from "Treatise on Cold Damage Diseases") with modifications.

bubble_chart Differentiation of Similar Patterns

1. Stomach yang deficiency pattern and pattern of stomach cold: Stomach yang deficiency pattern is a manifestation of digestive function decline, belonging to yang deficiency generating internal cold, a deficiency-cold condition. It arises from dietary irregularities, excessive consumption of raw and cold foods, or overuse of cold and cooling medications that damage the stomach; or from constitutional weakness, inherent spleen-stomach weakness, self-declining yang qi, or prolonged illness causing internal damage, yang qi depletion, and internal exuberance of yin pathogens, leading to stomach yang damage. Its main clinical symptoms, besides a cold sensation in the stomach region and vomiting clear fluid, include a lingering stomachache accompanied by severe empty abdominal pain, preference for warmth and pressure, relief after eating, a pale tongue with thin white coating, and a deep, weak pulse. It differs from the pattern of stomach cold, which is caused by cold pathogens attacking the stomach, characterized by acute onset, short course, and more severe disease tendency.
2. Spleen-stomach yang deficiency pattern and pattern of stomach cold: Spleen-stomach yang deficiency pattern is a symptom and sign of digestive function decline, often accompanied by spleen yang deficiency failing to transport and transform properly, such as abdominal distension and fullness, especially after eating, loose stools; in severe cases, difficulty in urination, edema, or accompanied by weakness in the limbs, general fatigue, etc.; a pale tongue with tooth marks on the edges, white greasy coating, and a soggy, slippery pulse. The spleen and stomach are internally and externally related, favoring dryness and disliking dampness, their main function being the transportation and transformation of water and grain essence (nutrients), which primarily relies on the action of spleen yang. If spleen yang is weak and unable to transport and transform water and grain, abdominal distension and fullness occur, especially after eating, and difficulty in urination; if dampness flows into the stomach and intestines, loose stools result; if dampness overflows into the skin, edema occurs; spleen yang deficiency leads to mental fatigue and lack of strength, cold limbs. Grasping the disease cause, mechanism of disease, and symptom characteristics of spleen-stomach yang deficiency pattern makes it not difficult to differentiate from stomach cold syndrome.
3. Pattern of cold fluid retention in the stomach and pattern of stomach cold: The retention of fluid in the stomach is mostly due to inherent spleen-stomach yang qi deficiency, with external cold as a predisposing factor, where external pathogens trigger internal pathogens to cause disease. It is often due to pre-existing fluid retention, such as inadvertently catching cold or drinking cold, leading to increased fluid retention, gurgling sounds, and even vertigo, vomiting clear fluid. Its difference from the pattern of stomach cold lies in that cold fluid retention in the stomach is due to yang deficiency with fluid retention, focusing on the fluid, while the pattern of stomach cold is due to yang deficiency with cold exuberance, focusing on the cold; the pattern of cold fluid retention in the stomach rarely presents with stomachache at onset, and with inherent spleen-stomach yang qi deficiency, the transformation and distribution of water and grain essence is incomplete, leading to fluid retention in the stomach, gurgling sounds, worsened by cold food and drink, and upward reversal causing vomiting. Internal exuberance of cold fluid further damages middle yang (inherent yang deficiency, external cold damaging yang), preventing clear yang from rising, hence symptoms like dizziness and blurred vision, which are not seen in the pattern of stomach cold.

bubble_chart Documentation

1. Suwen-Jutong Lun: "Pain is caused by excessive cold, and it is the cold that causes the pain."
2. Zhengzhi Zhunsheng‧Zabing: "Inhaling cold air externally and consuming cold food internally causes cold to lodge between the stomach and intestines, leading to sudden pain. Treatments such as Erchen, Caoguo, Dried Ginger, Evodia Fruit, Fuyang Zhuweitang, and Alpinia Seed pills are recommended."
3. Zabing Guangyao. Spleen and Stomach Diseases: "If a person's spleen and stomach are inherently weak, even if food is digested, overeating can cause discomfort and pain in the abdomen, leading to diarrhea. This is due to deficiency cold, and warming and tonifying treatments combined with digestion-promoting methods are advisable."